Sa1568 Usefulness of the Package Adhesion Method With Four-Place Clip Polyglycolic Acid Sheets for Preventing Bleeding From Ulcers After Early Gastric Cancer Endoscopic Submucosal Dissection

Currently, the usefulness of polyglycolic acid sheets (PGA; NEOVEIL®, Gunze) and fibrin glue (BOLHEAL®, Kaketsuken) for hemostasis during gastroenterological surgery has been proven. PGA is now used for early gastric cancer surgery because of its expected usefulness in preventing bleeding from ulcers after endoscopic treatment. However, PGA is a very thin sheet that likely overlaps with moisture absorption soon after contact with gastric fluid, making complete sheet extension and package adhesion impossible. To resolve this, we cut PGA into short strips and inserted them via a forceps channel into the ulcer for adhesion. However, PGA sometimes fell off without adhesion to the ulcer bottom, thus taking time to cover the entire ulcer surface. [Objectives] This study aimed to devise a package adhesion method with 4-place clip PGA to prevent bleeding from ulcers after early gastric cancer endoscopic submucosal dissection (ESD) while preventing fall-off and reducing surgical time.